TBD Details
(No data provided.)
Key Issues
Increasing women's access to income and productive resources
Child Survival Activities
Safe Motherhood
TB
Family Planning
Budget Code Information
Mechanism ID:
Mechanism Name:
Prime Partner Name:
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17026
HIV Innovations for Improved Patient Outcomes in South Africa (Developing the Capacity of the South African Government to Achieve the eMTCT Action Framework Goals)
Mothers to Mothers (M2M)
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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HBHC
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250,000
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0
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Narrative:
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In COP2013, m2m will aim to provide quality facility-based and community linked education and psychosocial support services to pregnant women, new mothers and their partners to promote and support uptake and full utilisation of HIV counselling and testing, treatment and related health services. In this way, services will contribute to strengthening Prevention with Positives approaches and improving health outcomes and optimsing the quality of life of clients and their families. Mentor Mothers, working in 100 sites (25 model directly funded through our USAID award and 75 through co-funders) will provide ongoing education and support to clients. The core activities will include one-on-one client suppport; couples education sessions; support groups and group health talks. This will be augmented by Active Client Follow-up to track client's progress through the PMTCT continuum of care to increase retention; Two-way referrals to HIV/TB treatment, reproductive health, nutrition and other support services as well as community-based care and support among others. m2m will aim to ensure quality service provision at the programme sites to contribute to modelling of District MMP sites and provide learning platforms for District Mentor Mothers and programme staff. The programme sites will be located in the following Districts: Amathole, Gert Sibande, Enhlanzeni, Nkangala, Cape Metro, Ethekwini, Ugu, Umgungundlovu, Bojanala, Capricorn, Mopani, Tshwane. However, District coverage may be revised depending on levels of sustained co-funding to support the additional 75 programme sites.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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HVTB
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175,000
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0
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Narrative:
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During this fiscal year, m2m Mentor Mothers will be trained on TB to ensure they have the relevant knowledge to provide education on TB to clients attending antenatal and postnatal care and PMTCT. TB education will be provided to clients through daily one-on-one and group health talks and support group sessions in the 100 programme sites targeted for COP 2013. Mentor Mothers, working in 100 sites (25 model directly funded through our USAID award and 75 through co-funders) will provide ongoing education and support to clients. However, to improve on the quality and impact of TB support services m2m will seek to integrate TB pre-screening as part of the package of TB support services. This will involve training of Mentor Mothers on TB pre-screening and formal client referrals, informed by National TB guidelines and standard operating procedures at facility level. Activities will involve leveraging and adaptation of existing pre-screening tools; formal referrral of clients and their families for screening and linkages to treatment programmes where required. m2m will aim to utilise successes and learnings from this initiative to provide technical assistance to Districts implementing the Mentor Mother programme to integrate a more comprehensive TB support package of services in their MMP sites, also providing in-service training to Mentor Mothers and MMP programme staff as required.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Prevention
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MTCT
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2,784,469
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0
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Narrative:
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In COP2013, mothers2mothers will work with the South African Government to build a sustainable and institutionalised Mentor Mother Programme (MMP), for integration of peer-based quality PMTCT education and psychosocial support services at the district level. m2m will implement 3 overarching key activities as follows: (i)m2m will provide technical assistance to the Department of Health PMTCT/MNCH Directorate(s) to develop a national and contexualised Provincial and District MMP through policy advisory and programme development technical support. m2m will provide technical support to SAG to develop a Framework for the MMP. A bottom-up approach will be employed to develop the capacity of District Health Management Teams (DHMTs) to implement the model, use lessons learned and scale-up from district level to culminate in an overarching National programme. The targeted Provinces are Limpopo, KwaZulu-Natal, Mpumalanga, Gauteng, Free State and North West; (ii) Provide cutomised training, ongoing technical support, mentorship and supportive supervision to DHMTs and health facilities. Capacity building will be provided to Districts to develop and implement their MMP integration Workplans as a core component of their overal Annual Business Plans; (iii) Develop Mentor Mother model innovations to be tested in 25 model sites, adapted for scale-up with knowledge and skills transfer to DHMTs to roll-out in public health facilities. m2m will facilitate quality improvement and responsiveness of the MMP to support tracking of mother-baby pairs for improvement of client retention, as well as a broader scope of related health issues such as TB and infant nutrition. In COP 2013, m2m will identify priority model expansion initiatives to continously broaden the scope of health support services provided through the model, which will in turn inform the continued enhancement of the MMP under DHMTs. These will include (re)designing a cost effective, scalable mother-baby pair tracking method including use of mobile phone technology for routine data collection and tracking; developing and testing a facility-community referral support system for clients to ensure a continuum of care; and consolidating and broadening TB and NACS integration activities initiatied in COP 2012.
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Implementing Mechanism Details
Mechanism ID: 17027
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Mechanism Name: HIV Innovations for Improved Patient Outcomes for Priority Populations (Supporting the SA Government to Develop, Implement and Evaluate a National Sex Worker and Male Client Plan)
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Funding Agency: U.S. Agency for International Development
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Procurement Type: Cooperative Agreement
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Prime Partner Name: Wits Reproductive Health& HIV Institute
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Agreement Start Date: Redacted
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Agreement End Date: Redacted
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TBD: No
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New Mechanism: Yes
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Global Fund / Multilateral Engagement: No
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G2G: No
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Managing Agency:
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Total Funding: 2,602,760
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Funding Source
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Funding Amount
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GHP-State
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2,602,760
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Sub Partner Name(s)
North Star Alliance
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Sisonke Sex Worker Movement
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Overview Narrative
WRHI’s National Sex Worker and Male Client Programme supports the South African Government to develop, implement and evaluate a “package of treatment services for HIV, STI and TB for key populations” as referred to in the National Strategic Plan. In 2013, WRHI is targetting implementation of clinical services at 8 different national sites (2 sex workers- and 6 truckers and sex workers- focused). Using WRHI’s Hillbrow model, this program will expand services to identified hot spot locations focussing on areas along major trucking routes where services do not exist and where there are large concentrations of brothel- and street-based sex workers. Services will include the Hillbrow package of treatment and prevention for sex workers, and will apply lessons learnt from the inner city’s Men’s Programme, which draws high-risk men into prevention programmes. The targeted locations include Tshwane, Johannesburg, Ekurhuleni, Cape Town, Zululand, Emakhazeni and eThekwini municipalities. Cost sharing opportunities will be leveraged through this programme at all levels within the DoH and include HIV test kits, condoms, drug supplies and referral support. WRHI and North Star (sub-partner) will involve corporate contribution to the project, based on successful public-private partnership records from both organisations. Corporate partners have already expressed interest in financial support of this program. WRHI has also engaged DoH from the start for transition and to ensure sustainability and local health department ownership. M&E is an integral component of and cross cuts through all of WRHI’s programmatic teams. The M&E team will expand WRHI’s current Women at Risk programme and Men and HIV programme’s comprehensive routine reporting tool for use in this program.
Cross-Cutting Budget Attribution(s)
Gender: GBV
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1,050,000
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Human Resources for Health
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680,000
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Key Populations: FSW
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1,491,003
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Motor Vehicles: Purchased
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172,230
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TBD Details
(No data provided.)
Key Issues
Implement activities to change harmful gender norms & promote positive gender norms
Increase gender equity in HIV prevention, care, treatment and support
Increasing women's legal rights and protection
Malaria (PMI)
Mobile Population
Safe Motherhood
TB
Family Planning
Budget Code Information
Mechanism ID:
Mechanism Name:
Prime Partner Name:
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17027
HIV Innovations for Improved Patient Outcomes for Priority Populations (Supporting the SA Government to Develop, Implement and Evaluate a National Sex Worker and Male Client Plan)
Wits Reproductive Health& HIV Institute
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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HBHC
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451,380
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0
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Narrative:
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WRHI has over a decade’s experience developing one of Africa’s largest sex worker treatment, care and prevention programs in Hillbrow, located in the inner city of Johannesburg, with over 2000 sex workers on their database. This program provides clinic and outreach services to brothel and street-based sex workers and their clients using community and peer educator components. Services include HCT, TB screening, STI diagnosis and treatment, family planning, antiretroviral therapy initiation, condom distribution and pregnancy testing. WRHI’s National Sex Worker and Male Client Programme will expand the Hillbrow model of outreach and treatment to also include Pretoria and Ekurhuleni, sites identified by the DoH as having a high concentration of sex workers. This program will also expand services for truck drivers and sex workers nationally, targeting expansion to five satellite sites and one specialist referral site along trucking corridors where services do not currently exist (Ekurhuleni, Cape Town, Northern KwazuluNatal, Emakhazeni and eThekwini municipalities) in 2013. This program will implement clinical and outreach services through identified clinic space or via a clinic container at each site. North Star, which has extensive experience in working with trucking communities, will manage the implementation of these Roadside Wellness Centres. North Star has experience in deploying wellness clinics in SADC Member States. These sites will provide services in basic sexual and reproductive health interventions (contraceptive provision, HIV testing and staging, STI treatment), TB screening, chronic disease screening, treatment of minor ailments, referrals to community structures, and accelerated access to antiretroviral therapy for all HIV-identified patients. The site in southern Johannesburg will act as a specialist site for complex care. WRHI will also work closely with industry wellness programmes in order for cross-linkages regarding referrals and gaps in service. Follow-up of truck drivers will be explored through SMS support, where WRHI has experience using this to support adherence among pregnant women and research participants. Modelled after the Hillbrow program, sex workers who default after being initiated on ARVs are assigned to the community health worker for follow-up. Additionally, Sisonke (sub-partner), a sex worker peer educator and human rights movement, will be establishing branches at selected sites. Through peer educators, Sisonke provides health information, legal support, life skills training, and linkages for clients to community services. WRHI will provide technical support, and ensure smooth relationships between Sisonke, DoH structures, AIDS Councils, and the police.
Finally, to monitor the quality of care, perform programme evaluations and research to identify priority issues, there will be implementation of a clinical data system to allow better characterisation of sex worker and truckers health needs as a component of the monitoring and evaluation system. This data system will be based on the current WRHI sex worker database and North Star’s tailored database system developed specifically to track truckers across regions.
Annual audits on clinical services for systems strengthening will be performed and identification of gaps in services and staff training will be planned to improve the quality of services.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Care
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HVTB
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451,380
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0
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Narrative:
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Prior COP activity was focused on the Hillbrow site, where the program has been very successful in partnership with the local municipality. A database provides outcomes of the program, which has provided extensive operational data. The project has excellent relations with the surrounding brothel owners & attached sex workers, as well as with the street-based sex workers. Referral into services is relatively simple, as other WRHI programmes focus on health systems strengthening in the inner city, & hence sophisticated understandings of the local referral networks strengths & weaknesses. WRHI’s National Sex Worker & Male Client Programme addresses the South African Government’s goal of a “long & healthy life for all South Africans” through expansion of targeted sex worker & trucking wellness services. Within the NSP there is specific reference to a “package of treatment services for HIV, STI & TB for key populations” which WRHI’s program aims to develop & deliver. At the SANAC Project Implementation Committee meeting in March 2012, it was agreed that there would be 1000 additional service points targeting key populations in response to implementing the NSP. WRHI’s program will contribute to the addition of these national service points through clinical & outreach programme delivery.
To coordinate activity across partners, WRHI is a member of a new DoH steering committee which brings together stakeholders from government, civil society & academic institutions, working in the field for sex work. Initiatives of this committee include the development of sex worker guidelines for health service provision. WRHI is also working with local partners to develop a national surveillance tool for sex workers allowing for regular activity mapping to guide where interventions should be introduced & monitor the impact of existing interventions.
Sufficiently trained personnel are essential to delivering programmes to these key populations. Truckers & sex workers face additional barriers in accessing HIV & TB care. WRHI’s training department has developed an advanced HIV & TB course to support doctors & nurses based in public referral sites. WRHI also provides specialized modular sexual & reproductive health courses for nurses & other core service delivery staff at facility level & provide evaluated curricula in basic SRH, TB & HIV for community members appropriate for the empowerment of community sex worker advisory boards & outreach workers. All training will be reviewed & adapted for this COP & will help ensure that there is sufficiently trained staff to carry out the proposed activities in satellite communities.
WRHI’s Monitoring & Evaluation team’s support is cross cutting through providing support for program monitoring, reporting, data quality, operations research, data use, Health Management Information Systems & others. This project focuses on providing health services to two underserved & under-represented populations. Currently there are no program monitoring indicators available for these populations thus project input, process, outcome indicators will be developed with the intention that some of the indicators will be integrated in the national databases. Program outcomes will be regularly reported for the indicators listed in the M&E plan. As detailed in the SI section of the COP, this project will undertake formative research to gain a better understanding of the needs of these populations.
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Strategic Area
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Budget Code
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Planned Amount
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On Hold Amount
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Treatment
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HTXS
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1,700,000
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0
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Narrative:
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Support for adult treatment will focus on technical assistance at the national, provincial, district, facility and community level of care. Technical assistance includes training, mentoring, monitoring, evaluation, quality improvement (QI), problem identification with formulation of solutions and ensuring systems are implemented to provide routine quality clinical service. HIV infected adults in this population including those with TB will be targeted in this program.
Support is offered to all cadres of health care workers. WRHI district team members work together, with one clinician providing clinical support to release DoH clinical staff, whilst colleagues provide onsite supportive training, mentorship and facilitation of NIMART accreditation, and “supermentorship” for DoH NIMART mentors together with QI support. Quality of care with a focus on retention in care and referral systems is strengthened through institutionalizing continuous QI methodologies, process mapping and the use of National Core Standards. Use of routine available data will identify the facility and sub-district-specific priority areas where targets are not being met. QI interventions will target these specific issues with measurable outcomes, and empower facility managers to implement improvements.
Retention in care and adequate referral will be supported using PHC re-engineering staff to ensure tracing and follow-up occurs. WRHI will ensure referral of complex HIV cases occurs efficiently, and that loss to pre-ART and ART programs is minimized. Novel mechanisms to improve retention in care will be developed and implemented, including the use of mHealth technologies. Within the referral service, non-adherent patients will be identified. WRHI will develop a model of support for patients failing ART and TB treatment, who require specialized support, to prevent unnecessary morbidity. Continued training and skills transfer will enable the system to become self-sustaining in the future.
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